Closing the gap: appropriate mental health treatment for all
Nearly a decade ago, the Institutes of Medicine (IOM) released the report “Unequal Treatment, Confronting Racial and Ethnic Disparities in Health Care,” which drew attention to the inconsistencies in treating minorities. The Center for Disease Control’s Office of Minority Health and Health Disparities released findings that extend this inequity to women and children. Slow progress is being made to rectify disproportionate treatment, but much more needs to be done.
A number of factors contribute to treatment disparity, including stereotyping, according to Richard Gabriel Frank, Ph.D., Margaret T. Morris Professor of Health Economics in the Department of Health Care Policy at Harvard Medical School. “An African-American with schizophrenia is more likely to be hospitalized and get older antipsychotic drugs than whites. Hospitalization costs more and is less appropriate or effective,” he says. “The individual suffers impairment from functioning, working and participating in larger society. There is also a greater risk of homelessness.”
Stereotyping aside, better collaboration between medical doctors and mental health practitioners could reduce complications due to co morbid conditions. “Medical doctors don’t look at a patient’s psychological health, but it goes both ways. Mental health professionals are quite lax in terms of physical health issues,” Frank says. “For instance, bipolar disorder and schizophrenia come with lots of physical problems, such as diabetes, heart disease and hypertension. Mental health clinicians are far less attuned to those things than they should be. There is a tendency to want the primary care physician to explain [psychological concerns], but the mental health community has to look in the mirror.”
According to Stacey Lambert, Psy.D., director of the Latino Mental Health Program at the Massachusetts School of Professional Psychology, cultural practices and values account for some of the disparity. “[Asian-Americans’] worldview is the most dissimilar to Americans about the mind-body conception of a problem. It does not translate to mainstream American psychological care,” she says.
African-American values are not quite as dissimilar, but this group uses a “collectivist/family approach,” Lambert explains. “They go through informal channels like family or church.”
Lambert adds that limited clinic hours, lack of on-site childcare services and few or no Spanish-speaking administrative personnel form additional barriers, but one of the most significant factors is an inadequate supply of minority psychologists, particularly those who speak Spanish. “According to the American Psychological Association, only two percent of psychologists self-identify as Latino, but between 15 and 25 percent of the population is Latino,” she says “Compared to the number of mental health providers, this represents a supply-demand mismatch.” She points out that recruiting minority students continues to pose a challenge.
Cognizant of the issue, accrediting bodies have begun to advocate integrating cultural competencies throughout psychology programs. “In the last 15 years, the APA has mandated multi-cultural courses,” Lambert says. MSPP offers a Latino Health Program, an immersion experience comprising language training, didactics and social construct. “We’re trying to educate providers about cultural and language competency to make services more accessible,” Lambert says.
In addition to disparities between ethnic minorities and whites, children have been left behind insofar as appropriate mental health care is concerned, according to Nicholas Covino, Ph.D., MSPP’s president. “We have knowledge of the Jimmy Fund and other causes, but the numbers of children with mental illness pale against medical conditions. Depression among children is bigger than cancer in its incidence and impact,” he says, citing escalating rates of anxiety, schizophrenia and suicide among young individuals. “Policy makers, politicians and health care companies look beyond mental illness and fail to see a contribution to other health issues and their repercussions.”
But hope may be on the horizon. More than $100 million has been earmarked for the creation of programs within mental health centers as part of the Affordable Care Act (ACA), Frank reports. “This will bring more mental health training and expertise to family health centers. Coverage expansions are targeted at low-income minorities and communities. These people are over-represented among the uninsured,” he says. “They will be getting fairly comprehensive insurance for the first time. The really important thing the ACA does is give greater fairness and participation for people with mental disorders. Coupled with parity, this is a good thing.”